Information Collection

Medicaid Program Budget Report (CMS-37), and Supporting Regs.

IC 7846 under ICR 201103-0938-009 · OMB 0938-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0101 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-37 Medicaid Program Budget Report (CMS-37), and Supporting Regs. Form
CMS-37 Medicaid Program Budget Report Screen Shots for CMS.37.docx Form
CMS-37-PRA Disclosure.doc CMS-37-PRA Disclosure IC Document
CMS-37 - Crosswalk.xlsx CMS-37 - Crosswalk IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid Program Budget Report (CMS-37), and Supporting Regs.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 430.30(a)(1) 42 CFR 430.30(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-37	Medicaid Program Budget Report	Screen Shots for CMS.37.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	224	224
Annual IC Time Burden (Hours)	7,616	7,616
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-37-PRA Disclosure	CMS-37-PRA Disclosure.doc	07/08/2008
CMS-37 - Crosswalk	CMS-37 - Crosswalk.xlsx	02/26/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.